Know before you vote: LARCs reduce teen pregnancy, especially when they are free.

In early October, researchers from the Washington University School of Medicine in St. Louis published a study showing that providing teens and adult women with access to free birth control dramatically decreased teen birth rates as well as abortion rates. Bet that didn’t make you spit coffee onto your monitor. It just makes logical sense.

What might get your attention is just how much those rates decreased. Let’s focus on the teen birth rates. For context, the overall teen birth rate in Missouri in 2010 was 37.1 births per 1000 females ages 15-19. The national teen birth rate in 2010 was 34.4 per 1000. The teen birth rate for study participants was 6.3 per 1000. That is an incredible difference. Teen birth rates that low are more typically found in Germany, France, and the Netherlands, in other words, countries whose health outcomes are generally and objectively better than health outcomes in the US. That is a difference that, if replicated on a large scale in this country, would have a profound impact, not only on federal, state, and local budgets, but more importantly on the lives of teens growing into adulthood without the challenges posed by raising a child at such a young age.

The good news is we have policies and medical guidance in place now to support major reductions in teen birth rates across the US. The bad news is at least some of those are in jeopardy this election season.

Two key factors facilitated the sharp reductions in teen birth rates observed in the St. Louis study.

Participants received an evidence-based contraceptive counseling session, including information on the safety and effectiveness of long-acting, reversible contraceptives (LARCs), and then were able to select the birth control method of their choice.

Participants received their preferred method of birth control at no cost.

LARCs are the most effective birth control methods available. Once inserted, they protect against pregnancy for an extended period of time and don’t require repeated dosing in order to work. Women report high levels of satisfaction with these methods. Intrauterine devices (IUDs) and implants are examples of these safe and effective birth control methods.

Despite their excellent track record, LARCs are used less in the US than in other developed countries, likely accounting, in part, for the higher teen birth rates here. Only 5% of women nationally have an IUD, and 2-3% have implants. By talking about the benefits of LARCs, the researchers in the St. Louis study expected that participants would choose LARCs at about twice this level. In fact, 75% of the participants chose LARCs. Turns out that routine, evidence-based contraceptive counseling makes a difference.

Not coincidentally, that is just what the American College of Obstetricians and Gynecologists (ACOG) recommends. In September ACOG updated their guidance for teens, saying that LARCs should be “first-line recommendations” for all adolescents and an essential part of reducing the rates of unintended pregnancies in the US. They also said that counseling about LARC methods should happen every time teens visit a health care provider, in order to make LARCs more accessible to teens.

The main drawback to LARCs is that they have a high up-front cost compared to other methods of birth control. This barrier is especially relevant for teens, which brings us to item #2: providing birth control at no cost.

Multiple studies have demonstrated that removing cost barriers increases access and use of birth control, particularly LARCs. The Affordable Care Act, otherwise known as Obamacare, requires insurance to cover certain preventive health services at no cost to women. Birth control, including LARCs, is on that list. If Obamacare were repealed, this coverage would disappear, and it would have real consequences for teens, their families, and their communities.

Throughout the campaign, it has become increasingly clear that the major parties differ sharply on their approach to women’s reproductive health and thus teen reproductive health. The contraceptive coverage provision of Obamacare has drawn particular fire. The fact of the matter is that until insurance companies were required to cover birth control at no cost, many did not, and millions of women faced cost barriers to basic, preventive medical care. Increasing access to birth control is a proven strategy for reducing teen pregnancy. When you get to the ballot box, look for candidates who support it.